The purpose of this Preventive Oncology Academic Award is to enable Paul C Schroy III, M.D. to acquire additional training in new disciplines relevant to preventive oncology and to initiate community-based research that addresses critical issues in the area of colorectal cancer prevention and early detection. Dr. Schroy's educational goals are to 1) obtain a master of Public Health degree; 2) acquire multidisciplinary expertise in areas relevant to preventive oncology through frequent interactions with various sponsors, consultants and co-investigators, and 3.) expand participation in ongoing cancer prevention activities at Boston University Medical Center and outside organizations such as the American Cancer Society and Boston's Center for Community Health, Education, Research and Service (CCHERS). Dr. Schroy's first research objective is to develop, implement an evaluate a model for primary care-directed community-based colorectal cancer control. The model employs a two-tiered strategy which consists of 1) an on-site practice-oriented provider education program, which includes both didactic and sigmidoscopy training, to enhance provider compliance, and 2) provisions for on-site primary care directed colorectal screening services. The model's impact on provider attitudes and practice patterns will be evaluated at 10 Neighborhood Health Centers (NHCs), including 5 intervention and 5 control sites, using a quasi-experimental design. Provider attitudes and practice patterns will be monitored and compared using pre-post-educational surveys and sigmoidoscopy appointment schedules, respectively. Dr. Schroy's second research objective is to identify demographic, behavioral, and/or psychosocial determinants of compliance with screening sigmoidoscopy for racially/ethnically-diverse inner city populations. To achieve this goal, the plan is to: 1) arrange focus group interviews at select NHCs. 2) develop a survey instrument utilizing data derived from the focus groups; 3) conduct an expanded survey of patients referred for sigmoidoscopy at select NHCs to assess the validity and generalizability of the focus group data; and 4) compare responses from compliers and noncompliers to identify discriminating factors. Dr. Schroy's third research objective is to further define the clinical role of molecular testing for the p21ras oncoprotein. Specifically, he plans to 1) determine whether the prevalence and/or type of p21ras mutation(s) in colorectal adenomas/carcinomas varies among racially- /ethnically-diverse high-risk groups to justify expanded population testing. 2) continue ongoing correlative studies to define the relationship between p21ras mutational status and clinicopathologic determinants of adenoma progression, 3) establish a database from which to assess the predictive value of p21ras mutational status with respect to patient outcome at a 3-year surveillance colonoscopy.